Hello COMSEP!
Happy midsummer. Today is the day in the northern hemisphere that the sun is tilted closest to the earth, and it certainly feels that way.
Stay cool, read the COMSEP Journal Club, and think about undergraduate medical education.
Enjoy,
Amit, Karen and Jon
It’s not personal
Olvet D, Willey JM, Bird JB, et al. Third-year medical students impersonalize and hedge when providing negative upward feedback to clinical faculty. 2021. Medical Teacher. 43(6): 700-708. https://doi.org/10.1080/0142159X.2021.1892619
Reviewed by Adam DeLong MD and Maggie Costich, MD, MS
What was the study question?
Do medical students on clinical rotations provide personalized, candid upward feedback in end-of-clerkship evaluations?
How was this study done?
The authors reviewed open-ended responses on end-of-clerkship evaluations from third-year students at a single institution across the 2018-2019 academic year. They focused on comments in which students provided feedback on attending or resident physicians, and they used politeness theory as a conceptual framework. The clerkship evaluation template was modified halfway through the year to instruct students to provide the full name of any faculty/resident addressed in feedback. The open-ended responses were coded for impersonalization (e.g. ‘attendings’ vs. ‘Dr. Smith’) and the presence of hedging strategies, specifically passive language (phrases signaling non-commitment), variable experience (phrases indicating that a negative experience was unique and not universal), and qualification of negative experiences with positive ones.
What were the results?
Students were significantly more likely to identify faculty/residents by name when providing feedback on what worked well (59%) rather than when offering suggestions for improvement (28%). Students were also significantly more likely to include the name of the resident/attending after instructions to personalize the feedback were added (75% vs 35%).
Additionally, students were more likely to use all forms of hedging language when providing suggestions for improvement (61%) as compared to feedback on what worked well (2%).
What are the implications?
Medical students are more often than not uncomfortable with providing targeted, frank constructive upward feedback to faculty and residents, even when feedback is anonymous and has no impact on clerkship grades. With impersonalized or hedged feedback, it is harder for faculty/residents to learn what is working and what is not to create change. Greater efforts to create open, safe learning environments where bidirectional feedback is encouraged are needed to ensure that upward feedback is direct and constructive.
Editor’s note: Many of us encourage our students to ask for feedback verbally, as this often can feel more low-stakes. I wonder if taking the same approach with faculty (i.e. encouraging them to ask for verbal feedback) would help address the concerns in the article, or whether it would make it worse. (JG)
Can I be on the team?
Simek K, Edwards M, Levy R, Seltz B. Impact of a Pediatric Night Float on Medical Students’ Education: Clerkship Student Perspectives. Hospital Pediatrics, 2022; 12(6): 583-9. https://dx.doi.org/10.1542/hpeds.2022-006557
Reviewed by Maya Neeley
What was the study question?
What is the perceived impact of a night float system on learning during a pediatric clerkship?
How was the study done?
Semi-structured interviews were conducted with third year students who participated in a night float experience from June 2019 to April 2021 at an academic children’s quaternary care hospital. The night float experience consisted of up to one consecutive week of nights, working with either residents or a pediatric nocturnist. Using grounded theory methodology, data analysis generated 4 major themes.
What were the results?
Nineteen students participated in this study, 13 of whom worked with residents and 6 of whom worked with hospitalists; there were no significant differences noted in responses from the two groups. The following themes emerged: (1) Professional Identity Formation (PIF): For some students, night float experiences appeared to contribute to PIF, with students describing greater involvement in patient care tasks. For others, who did not feel involved in the team or have a clear role, the night float system was less successful. Many stated that the experience was helpful in understanding what residency might look like. (2) Learning Activities: Students described the nighttime learning environment as less formal and allowing for more opportunities than the daytime learning environment. Some also appreciated the individualized teaching and feedback they received as the only learner present during that time. However, others experienced little teaching given how busy their preceptors were with other tasks. (3) Clinical Experiences: Many students described admitting a greater number and diversity of patients and diversity during the night float experience as compared to their daytime experience. They also commented on being given more complex tasks once their superiors saw “what you are capable of.” (4) Work-life balance: Many students had difficulty adjusting sleep-wake cycles and their schedules consisted mostly of work and sleep. While some appreciated being sent home early from their experiences, others felt that doing so made them feel less vital to the team.
What are the implications?
While this study suggests that night float may help students better understand the residency experience and promote professional identity formation, enhance learning opportunities, and provide them with broadened diversity/number of chief complaints, all of these are most enhanced when the learner felt like an integral team member with involvement in patient care. Furthermore, while night float experiences may be beneficial to learning overall, it is important to weigh those benefits against the disruption to normal life activities that often occur when on such a rotation.
Editor’s Comments: Students described both positive and negative impacts of a night-float system on their education. Positive experiences seemed to be most closely tied to their integration into the night team, which is likely more important than the call structure itself. How are students integrated into the on-call team at your institution? (KFo)
#PedsMatch21
Neelakantan M, Heitkamp NM, Blankenburg R, Frohna JG. The #PedsMatch21 Webinar Series: Coordinated Specialty-Level Communication During the Virtual Residency Application Cycle [published online ahead of print, 2022 Feb 8]. Acad Med. 2022;
https://dx.doi.org/10.1097/ACM.0000000000004623
Reviewed by: Caroline Qin
What was the study question?
Did a webinar series help facilitate communication between applicants and programs, address applicant concerns, and increase applicant access during the virtual 2020-2021 pediatric residency application cycle?
How was the study done?
Members of @FuturePedsRes (FPR), a Twitter-based student-led organization, developed and implemented the #PedsMatch21 webinar series with the Association of Pediatric Program Directors (APPD) and the Council on Medical Student Education in Pediatrics (COMSEP). The goals were to provide applicants with knowledge about virtual interviews, insight into programs, and live Q&A sessions. The series consisted of nine webinars (2 overview, 5 regional, 1 osteopathic [DO], 1 international [IMG]) conducted using Zoom. Surveys were administered after each webinar and at the end of the season.
What were the results?
Almost 140 residency programs participated in the #PedsMatch21 series. A mean (range) of 431 (90-936) participants attended each of the webinars, and applicants reported attending 1.4 webinars. Response rates for the post-webinar and the end-of-season surveys were 5-10% and 33%, respectively. Applicants who attended overview webinars reported significantly decreased anxiety levels and felt more informed about challenges related to virtual interviews. For applicants who attended regional webinars, 44% reported adding programs they intended to apply to. On the end-of season survey, all applicants agreed that the webinars provided reassurance and increased their understanding of the range of programs and the interview process. Compared to MD applicants, IMG and DO applicants more strongly agreed that they applied to additional programs following webinars. Areas for improvement included the applicant’s inability to select specific breakout sessions and inadequate opportunity to speak with all desired programs.
What are the implications?
The #PedsMatch21 webinar series is a novel, student-led method to help pediatric residency applicants engage with programs during a virtual application cycle. Results from their pilot season demonstrated that the series had a positive impact on applicants by giving them opportunities to address concerns and greater access to programs. Given that residency recruitment and interviewing may continue to be virtual, repeating the webinar series for future cycles will likely be beneficial for applicants. In addition, student-led and professional organizations in other medical specialties may consider implementing similar interventions.
Editor’s Note: Interesting study on how students felt about a webinar series on the match process. While response rates were low there were some positive findings of decreased anxiety and improved knowledge about the process. Results were more pronounced with DO and international graduates where formal dedication or access to knowledge on the process at their schools may be limited. (AP)